What is an oral appliance?

Answer: It is a piece of plastic or silicone that fits completely or partially within the mouth and holds oral structures in a position that allows easier breathing when you sleep.

Is there only one available?

Answer: There are many appliances commercially available. All of these appliances are accepted by the Food and Drug Administration for the treatment of obstructive sleep apnea.

Will an oral appliance help me?

Answer: This is very difficult to answer easily. Research shows that certain patients respond better to oral appliances. Positive characteristics are: normal weight, older than 18 and younger than 65, healthy teeth, being “buck toothed” with a small chin, a jaw line parallel with the floor (no device for Jay Leno!), a patient who has failed throat surgery, patients who have mild or moderate obstructive sleep apnea, people who have many more breathing events when they are on their backs. While there are many successful oral appliance users who do not fall within these guidelines, the fewer positive characteristics a patient has, the less successful he or she is expected to be.

Do they all work the same?

Answer: To this point there has been very little research which compares one custom fitted FDA accepted oral appliance to another. They have compared appliances which are custom fitted to those that are prefabricated and fit “while you wait”. It was found that those which were custom fitted were more comfortable, didn’t fall out as much and used with more comfort so they worked much more often that those that were prefabricated. Studies that compare two different custom fitted devices showed that both devices tested were statistically equal in effectiveness, but patients did have preferences based on design.

Keep in mind that the appliances are designed differently and have hardware in different positions. While the underlying effect of one appliance may be the same as the other, you may not be able to use a certain appliance because of the anatomy of your mouth or an allergic reaction. You want to work with a dentist who has knowledge of many different appliances.

How do I choose the correct appliance for me?

Answer: Our job is to help guide the patient to selecting an appliance that fits their lifestyle and their anatomy. Some appliances allow you to speak easily, others make it impossible. Not all of them allow you to breathe through your mouth if your nose is stuffy. They are like houses; one style is not right for everyone.

How long do they last?

Answer: The lifespan of an oral appliance varies depending on its design. They will last anywhere from six months to six years. Some require more repairs than others. Some must be sent back to the laboratory to be repaired, others can be repaired in the office. If you grind your teeth, you will shorten the lifespan of your appliance dramatically. Very severe grinders may find an appliance impossible to wear. Medicare guidelines state that they will only pay every 5 years for a new device so many patients will want to know the lifespan of the device they are to receive.

How do I know its working?

Answer: The real answer would be to have another sleep study, which would prove how effective the oral appliance is. Most patients will wait to be retested until their snoring stops and their symptoms go away.

How do I take care of my appliance?

Answer: Very much like you do your teeth. You need to brush the appliance thoroughly, both inside and out each morning when you take it out of your mouth. You need to pay attention to all of the hardware and small nooks and crannies. The best cleaning agent we have ever found to assist you in keeping your appliance clean is DentaSoak. It is available from Great Leaks Orthodontics Limited at 1-800-828-7626.

Are there side-effects from wearing these mouthpieces?

Answer: Of course: Short-term side effects include excessive salivation, dry mouth, tooth pain, and joint pain. All of these are easily corrected with time or adjustment of the appliance by your dentist. Long-term side effects are much more of a problem. The literature reports that as many as half the patients wearing an oral appliance long-term will have changes in the position of their teeth and sometimes their jaws. If you stop wearing the appliance in the first six months of use most of these changes are self correcting. After that it may require orthodontic therapy to put things back where they started. You need to let your dentist know immediately if you think there are any changes. You must balance the positive effect of the appliance against the negative side effect experience.

What is Sleep Apnea Dentists of New England’s success rate?

Answer: While we do not treat everyone evaluated, for people who are treated and are pleased with the outcome and continue wearing the device after one year, success would be about 75%. With time, and weight gain, devices can become ineffective and some patients who were originally successful, return to CPAP.

Why do I have to come back so many times?

Answer: The follow-up visits extend over the 3 month period during which side-effects are fully reversible. If, during that three month period, the patient is having real trouble maintaining his jaw in the original bite position, that patient must decide whether or not to continue using the oral device or to alternate its use with two nights of CPAP / week.

How long a process will this be?

Answer: Original fabrication of the device takes 2 visits and follow-up is 3 months. You will be seen every 6 month for the first two years of use and annually thereafter as long as you use your device. These follow-up visits are billed separately from the fabrication fee and may not be covered by you medical insurer.

Will my insurance pay?

Answer: That depends. Oral appliance therapy is considered medical treatment and only medical insurance will pay for this. Many employers have insurance contracts with specific clauses denying coverage for oral appliance therapy. Most major insurers now cover oral device therapy unless an employer asks to delete the benefit. If you belong to a PPO, EPO or HMO plan, it is possible there will not be an “in-network” provider and you will be held liable for much more than your annual deductible and co-payment.

I have dental insurance. Why do you need my medical insurance information?

Answer: Please click here to download our insurance brochure. This should answer this question.

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